• UHS (Bethlehem, PA)
    …Kingdom. www.uhs.com Qualifications Master Degree Required 5-8 year of experience Required of Utilization Review and Management Pennsylvania RN License or ... multi-disciplinary team while working in a state-of-the-art facility, including EPIC. The Utilization Review Director is responsible for overseeing the … more
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  • Surgery Partners (Bryan, TX)
    Job Summary: We are seeking a Part-Time Utilization Review Nurse to join our dedicated healthcare team. In this role, you will play a critical part in ... and must be worn. Qualifications, Knowledge & Ability: Current Registered Nurse ( RN ) license in...) license in the state of practice Experience in utilization review , acute hospital case management, or… more
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  • EvergreenHealth (Kirkland, WA)
    …provides intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support, and training of team ... for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our payers and… more
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  • Medical Solutions (Omaha, NE)
    …facility in Santa Barbara, CA is seeking its next amazing RN ( Registered Nurse ) to work in Case Management ( Utilization Review ). Read on if this ... sounds like your perfect fit! Nurses and allied healthcare professionals are in high demand nationwide, and our team of industry-leading, traveler-favorite recruiters can get you where you want to go - personally and professionally. Wherever you may roam,… more
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  • Alameda Health System (Oakland, CA)
    SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use of healthcare resources while ... and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of...IRR) Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California… more
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  • HEALTH FIRST CAREERS (Melbourne, FL)
    Job Requirements POSITION SUMMARY The Utilization Review (UR) nurse performs medical necessity reviews on all payer admissions to determine appropriate ... information that relates to insurance reimbursement in appropriate reviews. The UR Nurse utilizes advanced clinical skills to facilitate the provision of care… more
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  • Freeman Health System (Joplin, MO)
    …quality healthcare solutions. Schedule: Part-Time 30 hours per week What You'll Do The Utilization Review Coordinator provides utilization review to ... with regards to admission status and continued stay. Requirements Current Missouri Registered Nurse license or current Registered Nurse license from… more
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  • Mad River Community Hospital (Arcata, CA)
    …Specialty Case Manager RN Job ID 16149898 Job Title RN - Utilization Review RN Weekly Pay $2205.3 Shift Details Shift Days 3x12 Scheduled Hours 36 ... Job Order Details Start Date 03/05/2025 End Date 06/04/2025 Duration 13 Week(s) Client Details City Arcata State CA Zip Code 95518 more
    Upward (07/03/25)
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  • American Traveler (Salem, MA)
    American Traveler is hiring an experienced RN Case Manager with strong case management and discharge planning skills for a dayshift inpatient role. Job Details *Work ... EPIC as the electronic medical record system, Job Requirements *Active Massachusetts RN license required at time of consideration; MA conditional licenses are not… more
    Upward (07/21/25)
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  • AmeriHealth Caritas Health Plan (Philadelphia, PA)
    …judgment, and meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse , a sharp case manager, or a ... for Medical Director review as needed. We're Hiring for: General UM ( RN ): Mon-Fri, 8 AM-5:30 PM. Occasional evenings/weekends based on need. Pediatric Shift Care… more
    Upward (07/24/25)
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  • Kaiser Permanente (Los Angeles, CA)
    …graduates to take RN license exam. License, Certification, Registration Registered Nurse License (California) Basic Life Support Additional Requirements: ... the general and specialized principles, practices, techniques and methods of Utilization review /management, discharge planning or case management. Working… more
    Upward (07/27/25)
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  • Valley Health System (Paramus, NJ)
    …years'" cents experience in clinical nursing, minimum of 3 years in case management/ utilization . SPECIAL SKILLS: Registered Nurse , Licensed in State of New ... POSITION SUMMARY: Performs concurrent utilization review activities on all patients within the assigned caseload. Collaborates and educates the medical staff on… more
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  • Boston Childrens Hospital (Boston, MA)
    Utilization Management) preferred. Licensure/ Certifications: Current Massachusetts license as a Registered Nurse ( RN ) A certification as a Certified ... Job Posting Description Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess for… more
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  • Kaiser Permanente (Sacramento, CA)
    …Experience Minimum three (3) years of home care nursing experience or quality utilization review experience. Education Bachelors degree in nursing or related ... or General Education Development (GED) required. License, Certification, Registration Registered Nurse License (California) Additional Requirements: Current… more
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  • Molina Healthcare (Long Beach, CA)
    …required for internal meetings. JOB QUALIFICATIONS Required Education Completion of an accredited Registered Nurse ( RN ). Required Experience 1-3 years of ... clinic experience. Required License, Certification, Association Active, unrestricted State Registered Nursing ( RN ) license in good standing....in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management… more
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  • Northwell Health (Riverhead, NY)
    …case management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. Keeps ... of care according to regulatory standards. * Performs concurrent utilization management Conducts chart review for appropriateness...in Nursing, required. Current license to practice as a Registered Professional Nurse in New York State.… more
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  • A-Line Staffing Solutions (Harrisburg, PA)
    Job Description A-Line Staffing is now a motivated and detail- oriented Review and Elevation Registered Nurse In Harrisburg, PA Please contact Marcia ... processes and identify irregularities. A-Line Staffing is now a motivated and detail- oriented Review and Elevation Registered Nurse In Harrisburg, PA -… more
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  • NavitsPartners (Boston, MA)
    Job Title: Travel - Registered Nurse ( RN ) - Case Management Location: Hyannis, MA Assignment Type: Travel Contract Duration: 13 Weeks Shift: Monday to Friday ... - $2,890 Position Overview: We are seeking an experienced Registered Nurse ( RN ) specializing in...case management role Demonstrated experience in discharge planning and utilization review within the past 4 years… more
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  • Northpoint Recovery Holdings, LLC (Loveland, CO)
    Job Title: Registered Nurse ( RN ) - PRN Reports To: Director of Nursing Schedule: As needed Monday-Sunday Day Shift (6am-6pm); Also able to pick up available ... As a key member of the Northpoint team, the Registered Nurse ( RN ) will provide...compliance activities of the facility Provide medical updates to utilization review and representatives of managed care… more
    Upward (07/26/25)
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  • Day Kimball Healthcare (Putnam, CT)
    Registered Nurse , Case Manager Education and Experience Requirements: Licensed RN currently registered in State of Connecticut required. BSN or enrollment ... Day Kimball Health is hiring for a Registered Nurse , Case Manager for Case...the Case Management Department functions and activities to include Utilization Review /Case Management/Clinical Documentation/RAC. Carries out the… more
    Upward (07/29/25)
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